Eating disorders have been expanding dramatically in recent decades, and the COVID-19 pandemic appears to have pushed us to even higher rates of eating disorders. Hospital wards are full of children who need to be medically stabilized before they can even begin treatment for the condition.
The frustrating thing about the increasing rates of eating disorders is that we know many of them are preventable. As biopsychosocial disorders, they are rooted in heredity and individual psychology, but it is impossible to ignore the vast influence of our culture and the many ways in which it teaches our children the very behaviors that constitute eating disorders. You could almost say that eating disorders are a given outcome of our societal beliefs about weight, dieting, and eating.
Here are a few things that we know prevent eating disorders that we simply aren’t doing.
What prevents eating disorders: Teaching kids that dieting is unhealthy
Diet behaviors are eating disorder behaviors, and yet dieting is taught almost everywhere in our society. We know that dieting precedes almost all eating disorders. One study found that teens who dieted at a severe level were 18 times more likely to develop an eating disorder than those who did not diet. Those who dieted at a moderate level were five times more likely to develop an eating disorder than those who did not diet (BMJ). Parents who want to prevent eating disorders need to discourage and prevent diet behaviors of all types, including the seemingly innocuous “eating healthy” or “eating less and moving more” advice that characterizes most diets today.
We’re doing the opposite!
While nutrition education is important, our focus on weight control through dieting promotes eating disorders. Beginning in preschool, teachers and parents teach kids that dieting is a natural, normal, and healthy thing to do. From small side comments about needing to lose weight or watch what you eat to school programs telling kids to eat less and move more, we actively teach kids to diet in our schools and our homes. Doctors, coaches, and peers further perpetuate these lessons. This advice is given even though it is well established that 95% of women and 93% of men cannot maintain weight loss, regardless of the weight loss method, amount of weight lost, or starting BMI (IJES). In other words, diets have a 5% success rate. And the No. 1 predictor of both eating disorders and weight gain is dieting.
What prevents eating disorders: Normalizing body diversity
We know rigid beliefs about what a “good” or “healthy” body looks like and weighs promote eating disorders. Bodies vary greatly, and most of a person’s weight is heritable. Just like shoe size and height, we have little control over weight. Bodies can be fit and healthy across a broad spectrum of weight. Weight, except at the very extremes, is not an important indicator of health (IJE). When children are taught that bodies are meant to be diverse, that all bodies can be healthy and attractive, and that fat is not a sign of failure, gluttony, or sloth, they are protected from eating disorder behaviors and beliefs.
We’re doing the opposite!
Children are taught to fear weight gain from a very young age, even when it is a normal and healthy part of their physical development. For example, in puberty, a girl may gain significant weight. This weight gain is normal, but her parents, doctor, and others may encourage her to reduce her food intake and try to lose weight based on our societal belief that girls should keep their bodies small and pleasing. This belief encourages eating disorders and is a direct contributor to their development. It is the most likely reason that many eating disorders in girls begin soon after the onset of puberty.
What prevents eating disorders: Prioritizing family meals
We know that chaotic and inconsistent feeding and unpleasant meal experiences can contribute to eating disorders. More frequent family meals, placing a high priority on family meals, and a positive atmosphere at family meals are positively correlated with fewer cases of disordered eating (JAH). Families that prioritize family meals and make an effort to feed their kids consistently and in a positive environment can reduce the risk of eating disorders.
We’re doing the opposite!
In many families, there’s no time for family meals. Many families don’t share even one meal in a week. This means that kids are not getting the benefit of learning the importance of feeding the body and socializing around food. If feeding is consistently pushed to the backburner in the family, it’s not surprising if the child ends up having a chaotic and disordered relationship with food.
We can prevent eating disorders
We have the knowledge and the ability to prevent many eating disorders. As biopsychosocial disorders, they are heavily influenced by societal norms, beliefs, and behaviors. We set kids up for eating disorders as long as we vilify fat and praise dieting and weight loss. And until we teach kids emotional regulation, they will continue to be at risk for all forms of mental disorders.
Want to know more about eating disorders? I have a free eBook: What Kids Want Parents to Know About Eating Disorders